Background: Socio-cultural beliefs play a significant role in healthcare as they influence perceptions of health and illness for both the client and the healthcare provider. These beliefs may influence the need to use a variety of health care providers. By understanding the belief system of patients, clinical social workers can effectively meet the needs of the hospital patients. The aim of this paper was to explore the role of patients’ socio-cultural beliefs in a healthcare setting. Methodology: By means of an exploratory investigation with 24 patients at an academic hospital in Gauteng, this paper identifies some beliefs that patients bring with them into the healthcare institution. Herskovits in-depth relativist approach was used to analyze the data. This paper examines how beliefs contradict, enhance or complement clients’ experiences of health care within a hospital setting. The results illustrate that African traditional and cultural beliefs were reported to be affordable and enable people to connect with their ancestral spirits. Close relatives and traditional healers played an important role during illness and recovery. It is recommended that social workers should always engage with patients and other members of multi-disciplinary team for a holistic patient care approach. Social workers should communicate to holistically understand their patients.
According to Petrus and Bogapa (2007) [
Today, most social scientists view culture as consisting primarily of the symbolic, ideational, and intangible aspects of human societies (Ghiasuddin, Wong & Siu, 2016) [
South African society embraces both faith and traditional healing practices in addition to Western medical pluralism (Yen & Willbraham, 2003) [
Faith healing refers to a particular faith-based belief: for example, Hindu (Marquit, 2006) [
A socio-cultural approach will be used to unpack these beliefs. Bierwiaczonek and Waldzus (2016) [
Clinical social work is an old profession and in the last few years, has become a common area of practice in South Africa. Clinical social workers work closely with communities and are commonly based in hospitals and clinics (Dorfmann, Meyer & Morgan, 2012; Cooper & Lesser, 2008) [
Each society has its own socio-cultural beliefs needing to be appreciated by social and health professionals (Dorfmann et al., 2012) [
The literature indicates not all traditional customs and beliefs are harmful to people (Ginger & Davidhizar, 2004) [
A person’s cultural background often influences how they gain entry into the healthcare system and adherence to medication and treatment. All these factors play an important role in the eventual recovery of the patient from illness (Kangwa & Catron, 2011) [
Various studies have provided evidence that socio-cultural differences between clients and healthcare practitioners can have an effect on the relationship between the patient and the healthcare professional (i.e. nurse, psychologist, medical doctor etc.). Additionally, the state of the relationship often impacts the quality of healthcare provided to the client (Cooper & Lesser, 2008) [
This exploratory investigation was undertaken as part of the development of indigenous clinical social work where clients’ and patients’ perceptions and experiences are viewed as valuable and necessary sources of knowledge for healthcare practitioners.
This article presents findings on how socio-cultural beliefs influence healthcare seeking and service provision.
Chris Hani Baragwanath Academic Hospital is one of the largest hospitals in South Africa as well as in the world (Turner, 2013) [
In contributing to evidence-based practice and knowledge, the hospital serves as a teaching facility for the University of the Witwatersrand, Faculty of the Health Sciences (Turner, 2013) [
South Africa is currently one of the countries with highest inequality amongst its people. The poor still find it difficult to access essential services such as basic healthcare and education (Patel, 2005) [
One particular stipulation in the Code of Ethics as enshrined in the SACSSP practice guidelines is the importance of cultural competence training in social work education and training (SACSSP, 2012) [
Academics in institutions of higher learning should make certain students are equipped with knowledge ensuring they behave in a way which is inclusive of respect for clients’ social and cultural differences (NASW, 2001) [
There is also extensive literature and research addressing cultural belief and healthcare. Scholars are beginning to acknowledge individuals hold differing cultural and belief systems and these play a significant role in their healing (Kangwa & Catron, 2011; Ginger & Davidhizar, 2004) [
Juckett (2005) [
Efforts directed toward instituting more culturally relevant healthcare to enrich the physician-patient relationship and improve patient rapport, adherence, and outcomes should be made (Juckket, 2005; Cooper & Lesser, 2008) [
A responsive healthcare system should always be considerate of cultural beliefs as reflected in each context (Ginger & Davidhizar, 2007) [
Social workers practicing in hospitals and other health facilities need to utilize strategies actively engaging social and health issues of the poor and marginalized (Cooper & Lesser, 2008) [
Nevertheless, a patient is a member of society, and each society has a variety of social, cultural, political and economic factors which influence the patient’s way of thinking. As a result, indigenous people in most African societies tend to have various explanations concerning ill health. As alluded to earlier on such explanations have influence over whether or not the person will seek medical care (Arrendondo & Toporek, 2004; Cooper & Lesser, 2008) [
Carter (1995 [
The study was undertaken at Chris Hani Academic Hospital (CHABH) located at Soweto in Johannesburg, South Africa (Turner, 2013) [
As a training hospital, it is well equipped and motivated to serve the sick and injured as well as to maintain and defend truth, integrity and justice for all, at all times, to the benefit of patients, staff and the community (Horwitz, 2013) [
Soweto is a community in flux?belonging to both the first and third worlds. By recording and documenting the change in diseases and pathology, CHABH provides guidance to all who face similar situations worldwide (Horwitz, 2013) [
The CHBAH healthcare staff complement is predominantly African, and based on this observation it is assumed the understanding of socio-cultural aspects of each and every patient when one is not from an African background is likely to be a challenge. Furthermore, the researcher’s interactions and observation proved that social-cultural relevance should not be assumed when dealing with patients, irrespective of the attending staff being African or non-African, as cultural beliefs are diverse.
The study employed qualitative approach which was exploratory, descriptive and contextual. According to Babbie and Mouton (2001) [
Interviews are an interaction between the interviewer and the respondent in which the interviewer has a general plan but not a specific set of questions to be asked using particular words or a particular order (Babbie & Mouton, 2001). The phenomenological approach was also used to reflect socio-cultural beliefs influencing healthcare provision at the CHBAH. According to Crabtree and Miller (1999: 28) [
This study was conducted in a hospital setting?CHBAH. All participants were patients at the institution. A semi-structured interview was used to collect data. The semi-structured interview contained open-ended questions, and they were asked primarily in English. However, when necessary, IsiXhosa, IsiZulu, Northern Sotho or Setswana were used to collect the data. The purpose of using some South African languages was to ensure participants entirely understood the interview questions. The length of the interviews ranged between 30 - 60 minutes per participant. All the participants were interviewed within the physical environment and socio-cultural belief system in which they were admitted at the time. The data was analyzed using the thematic content analysis method. This allowed the researcher to identify, induce themes and analyze the data.
Twenty-five patients (25) took part in the study. All participants were selected through a purposive sampling technique. The age range was 21 to 65 years, 65 percent were women and 35 percent were men. Sixteen of the respondents were from an Nguni-speaking background meaning they either could speak and or understand IsiZulu or IsiXhosa. Six were from a Tswana-speaking background and three were from a Northern Sotho-speaking background. The researcher understood and could express herself in all four languages, which could be viewed as an advantage to minimize information distortions.
Thirty of the respondents honored their ancestors. For example, they performed traditional rituals as a form of isingxengxezo, meaning asking or informing their ancestors about the illness. Fifteen were affiliated to various religions. In discussing the results, the focus will be on six quotes which were considered critical and relevant to the study. It is generally assumed all Africans are the same or can believe in both ancestral worship and Christianity. However, in many instances this researcher encountered African patients who exclusively believed in traditional ways of dealing with their health related matters.
Descriptive analysis was employed to analyze the data. According to Creswell (1994) [
・ The researcher familiarized herself with the data by reading through the transcriptions and field notes repeatedly.
・ The first step enabled the researcher to obtain an idea of the data and as a result wrote down main points.
・ Identification of recurring themes and clustering those which are similar.
・ Encoding topics.
・ Generating descriptive wording for topics and turning them into categories.
・ Reducing topics by grouping those that were related (this serves as a basis for literature control).
・ Alphabetizing these codes.
・ Assembling data according to categories and conducting a preliminary analysis.
・ Recoding existing data where necessary.
(Creswell, 1994) [
To ensure reliability of the data, an independent coder was used. The independent coder analyzed the data, and the themes. Sub-themes were finalized by the researcher and the supervisor through consensus discussion. Literature control was also used to verify these findings. The researcher further took steps to establish data trustworthiness. This included credibility and confirmability testing of the data
The researcher adhered to the following ethical principles throughout the study. The researcher was aware this study may inflict emotional or psychological harm. For that reason, steps were taken to eradicate the possibility. All participants were protected from any physical and psychological harm, and were informed of the possible impact of the study.
The researcher also obtained informed consent from all participants. Strydom and Venter (2002) [
In addition, steps were taken to ensure participants’ anonymity and confidentiality. The researcher ensured research subjects’ right to privacy by not revealing their names; interviews were conducted privately in a counseling room; cassette tapes were wiped clean following transcription of the research report. Additionally, participants were informed the study was authorized by the University Medical Ethics Committee.
By way of demonstrating the relevance and significance of this paper, a few representative quotes drawn from the researcher’s interaction and observation offerinsights into how socio-cultural beliefs might influence healthcare in a hospital are provided. The researcher witnessed and intervened in a situation where Mr “X” requested to be released to visit his family and consult with his ancestors before a planned procedure. The medical practitioner could not understand him when he said “Ndiyavumaukuhlinzwa kodwa ndicela ukuya ekhaya ndithethe nezinyanya.” This translates as “I do consent to the operation, but I need to visit my ancestors at home (Transkei).”
The practitioner interpreted this request as a delaying tactic. The researcher understood the significance the patient’s request in terms of the belief that the success of the operation depended on his consultation with the ancestors. This request was then conveyed to the medical practitioner who then allowed the patient to visit his family.
In another incident, a patient diagnosed with a psychotic disorder was admitted repeatedly, and he also requested to consult with his traditional healer for treatment:
“Ukubano inyanga nokuphuza imithi yesintu yikho okwalaphayo. Isifo esifana nesi asalaphek i ngamayeza esilungu.” This translates as, “Diseases like this cannot be treated with Western medication.”
As a social worker, based on her understanding and cultural beliefs, the researcher was able acquiesce to the other healthcare professionals and patients. This was because I was able to explain to the patient that the medical staff was not against the consultation. However, the recurring admission could have been related to not taking or mixing the medication (traditional and Western). Based on this, an educational health talk had to be given to the patient and the patient’s significant others.
For example, a woman of the African tradition had to be taken to the operating theatre. Just before the preparation her mother-in-law visited her in the ward. The patient had not covered her head. She was extremely upset that she had not been informed that the mother-in-law was visiting and she felt embarrassed. For her, this was a sign that something was not going to come right in theatre. As a form of voicing her frustration, she said “Into yokokuba ndifumaneke ndihamba ngentloko phambi komamazala lihlazo, kwaye ihlola okubi”. Translated, this means, “The fact that my mother-in-law found me with a bare head is the sign that this operation is not going to be a success as I have disrespected the ancestors.”
Other healthcare professionals who were with the woman could not understand the source of her anger. I then intervened and spoke to her and to her mother separately and I did a joint session as I understood where she was coming from. The woman calmed down and was ready for the procedure.
Many cultural norms may influence patients’ behavior and appearance (Cooper & Lasser, 2008) [
Another patient said, “Thina ngesintu asinekelani ngegazi kuba izinyanya ziyakukumangalela.” This means, “I cannot donate blood, because if I do donate or receive blood from someone else, my ancestors will rebel or turn against me.” Blood transfusion is culturally and religiously unacceptable: one participant said, “Just imagine taking someone’s blood in my family.” Cultural beliefs influence health-related behavior all the time (Delgado, Jones & Rohani, 2005) [
Consider the Jehovah’s Witnesses’ spiritual concern that translates into refusal of blood transfusions. In the same vein, a heart patient with no understanding of nutrition and its role in health may not “believe” that a change in diet would be helpful, and consequently would refuse this intervention. “The question can’t be: Are there associations between health and belief?” says David Hufford, PhD, from Pennsylvania State Medical School. “The question is: What are they?”
In another instance, the researcher was called as the patient was about to leave the area (bed) where her six-month-old baby had died. She said, “Ndifuna ukwazi okokuba ndiyakulinkwa ilungelo lokumlanda apha phambi kokuba singcwabe.” This means, “I would like to understand whether we will be given permission as a family to fetch him before burial according to tradition.”
I had to explain to the patient that because the family was staying far away, the hospital could wait as other patients needed to be accommodated and arrangements could be made even when the deceased is fetched from the hospital mortuary. The patient understood the importance of taking other patients’ needs into consideration without feeling that her beliefs were being undermined. In summary, all these examples reveal the influence of socio-cultural belief in healthcare. Based on the discussion, the following became clear:
Understanding how social, structural, psychological, and cultural factors affect physical health, being sensitive to these factors can make an important difference in health outcomes (Delgado et al., 2005). Beliefs affect how and from whom a person will seek care, how self-care is managed, how health choices are made, and often, how a patient respond to a specific therapy (Cooper & Lesser, 2008; Delgado et al., 2005) [
Overall, the results confirm published studies about “Cross Cultural Medicine”. In an article published in American Family Physician in December 2005, the authors stated cultural competency is an essential skill for family physicians and initial interview should elicit the patient’s perception of the illness and any potential cultural conflicts between the physician and patient. This includes differing attitudes towards time and what is important in life. The previous quotes cited by the participants clearly indicate the importance of cultural sensitivity and the importance of language. Cultural understanding is imperative and the ability to speak the language is essential.
A variety of studies conducted in Burkina Faso, South Africa, Togo and Nigeria indicate blood donors harbor unfounded fears (Olaiya, Alakija, Ajala & Olatunji, 2004) [
In African countries many people are categorized in terms of an undifferentiated group, dictated by their “culture” which can be assumed primitive and superstitious compared to Western conceptualisations of health, illness, coping and stress. There is a construct that the “African mind” is an object of psychological knowledge, essentially vulnerable to social change (Lucas & Barrett, 1995) [
Lum (1997) [
In recent years, several developmental changes have come into being. These adjustments have chiefly been in the areas of education, urbanisation, economic improvement, subsequent changes in the standard of living and the adoption of Western religious practices. These changes have had enormous effect on the traditional structure of the Xhosa people especially in the practice of funeral rites. Funeral rites have become most elaborate since both traditional and modern ceremonies are performed at each funeral in the urban areas.
Sarangi (2001) [
Interactive relationship:
・ Ask your patients questions such as “Who else is involved in your healthcare? What is your belief system? Who makes up your support system?”
・ Ensure your patients understand your language.
・ Provide information in simple terms.
・ Record the proceedings, writing information in the patient’s healthcare card
・ Furthermore, healthcare facilities should establish formal guidelines available for use by all healthcare professionals, depending on the dominant socio- cultural beliefs in the catchment area.
This study explored and described the socio-cultural beliefs influencing healthcare at a South African public hospital. The overall aim of the paper is to encourage and recommend social workers and other healthcare professionals to become more sensitive to socio-cultural issues, considering the influence may have in providing healthcare.
Even though this paper specifically deals with socio-cultural beliefs and practices, it should be kept in mind that there are patients who do not adhere to any particular cultural belief. These patients equally deserve respect and understanding. Care should be taken not to assume when a patient declares to being “non-religious”, this person will have nothing to do with religious practices.
General guidelines related to socio-cultural beliefs should be considered and provided as guidelines to enable social workers and other members of the multi-professional team in a healthcare setting to optimize patient care.
Qualitative studies have both strengths and weaknesses (De Vos et al., 2006) [
Nkomo, T.S. (2017) The Influence of Socio-Cultural Beliefs in Chris Hani Baragwanath Academic Hospital (Chbah): A Social Work Perspective. Open Journal of Social Sciences, 5, 46- 59. https://doi.org/10.4236/jss.2017.58004